Health care delivery will change substantially in the coming years. This is not because of reform but rather due to a set of drivers that are exerting a great push and pull to the delivery system. Some of these changes will be quite transformational and some will be very disruptive of the status quo. What are these drivers?

One of the most important is that there will be many more individuals with chronic illness. [A recent study focused] on chronic illnesses and noted that nearly one half of Americans had one or more chronic illnesses, most of them preventable and which were costing the economy over $1 trillion per year and rapidly rising. These are diseases like diabetes with complications, heart failure, cancer, or chronic lung disease. What is apparent is that they are mostly due to adverse lifestyles [see: Obesity Leads To More Doctor Visits Than Smoking, Canada].

A second driver of change is the aging of the population. The American society is growing older and just like a car: “Old parts wear out.” .

Another driver is the increasing demand for medical services. Perhaps this is saying the same thing another way. More aging and adverse lifestyles create more disease and the need for care.

Consumerism is becoming ... more and more of a driver of change. Patients are coming to want and expect to be treated like a valued customer....They want service, good service. ....They want interaction by email and other electronic methods.

...[P]atients increasingly expect to have a closing of the information gap – they expect the playing field between patient and doctor to be much more level in the future.

Professional shortages are also definite drivers of change in the delivery system....These shortages are more acute in rural areas and urban poor areas. Combined with shortages are changes in professional aspirations and lifestyles.

More and more physicians want and expect to have more time for family and recreation. And they no longer want to run their own private practices. They prefer to be employed with little if any administrative burdens.

[P]atients will have greater requirements toward a direct share of costs....Among employer sponsored plans, there is an increasing push toward high deductible plans, with deductibles in the $1000-2000 range.

I have discussed a number of these same changes in previous posts. However, I would like to focus here on the predicted (e.g., physician) professional shortages (see: Doctor Shortage Likely to Worsen With Health Law). We are facing the "perfect storm" of the following factors that will likely cause such shortages: (1) more patients entering our healthcare system due to the Affordable Care Act (ACA); (2) the aging and retirement of a large cohort of healthcare professionals (e.g., pathologists and medical technologists); (3) changing lifestyle expectations on the part of recent medical graduates that will result in shorter workweeks for them; (4) fewer physicians entering private practice with the majority now working as salaried employees for health systems; as employees, they will undoubtedly work fewer hours.

Very few physician are slackers but I am convinced that physicians as employees of health systems will not work the long hours of private practitioners absent the financial incentives of private practice. In my mind, this idea was borne out when hospitals began to purchase private practices 20-30 years ago to ramp-up hospital referrals. This idea often backfired and hospitals overpayed for the practices because the now physician employees lacked the incentives to work as hard as they did previously when working for themselves.